Predictors of wound complications following major amputation for critical limb ischemia
Predictors of wound complications following major amputation for critical limb ischemia
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DOI：
10.1016/j.jvs.2011.04.048
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发表时间：
2011-11-01
影响因子：
4.3
通讯作者：
Hodgson, Kim J.
中科院分区：
文献类型：
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作者：
Hasanadka, Ravishankar;McLafferty, Robert B.;Hodgson, Kim J.
目的：对于患有终末期严重肢体缺血（CLI）的患者，他们已经遭受了很长一段时间，没有伤口并发症的大截肢仍然是至关重要的。利用美国外科医师学会的数据，国家外科质量改进计划（ACS-NSQIP），本报告的目的是确定导致伤口并发症的关键因素后major amputation.Methods：ACS-NSQIP被用来确定患者>= 50岁，CLI，并有同侧膝下（BKA）或膝上截肢（AKA）。主要结局为伤口发生率（WO），定义为浅表感染、深部感染和/或伤口破裂的肯定结果。次要结局为30天死亡率。单变量分析后，进行多元Logistic回归，以确定预测factors.Results：2005年1月1日至2008年12月31日，4250例患者符合纳入标准（2309 BKAs和1941 AKA）。BKA的WO为10.4%，AKA为7.2%。对于BKAs，国际标准化比值（INR）的增加预测更多的WO（P = 0.008，INR每增加一个积分的比值比[OR] 1.5），与年龄50至59岁的老年患者相比（P = 0.002，OR 1.9）。对于AKA，目前吸烟者预测更多的WO（P = 0.0008，OR 1.8），体重指数（BMI）增加（BMI每增加10 kg/m2，P = 0.02，OR 1.3）。BKA的死亡率为7.6%，AKA为12%。完全功能依赖性是AKA后死亡率的最佳预测因素（P <0.0001，OR 2.5）。医学合并症，如心肌梗死（MI）病史（OR 1.8），充血性心力衰竭（CHF，OR 1.6）和慢性阻塞性肺疾病（COPD，OR 1.6）预测BKA后的死亡率，而透析使用（OR 2.4），CHF（OR 2.3）和COPD（OR 2.1）预测AKA后的死亡率。CLI大截肢后的伤口发生率和死亡率仍然是一个普遍的问题。BKA前INR正常化应减少WO。通过改善预防措施、早期疾病识别、更好的治疗和增加教育，提高高风险患者的认识，对于改善已经有压力的患者队列的结局仍然至关重要。（J Vase Surg 2011;54：1374-82.）
Objectives: For patients with end-stage critical limb ischemia (CLI) who have already suffered over an extended period of time, a major amputation that is free of wound complications remains paramount. Utilizing data from the American College of Surgeons, National Surgical Quality Improvement Program (ACS-NSQIP), the objective of this report was to determine critical factors leading to wound complications following major amputation.Methods: ACS-NSQIP was used to identify patients >= 50 years, with CLI, and having an ipsilateral below-(BKA) or above-knee amputation (AKA). The primary outcome was wound occurrence (WO) defined by affirmative findings of superficial infection, deep infection, and/or wound disruption. The secondary outcome was 30-day mortality. Following univariate analyses, a multiple logistic regression was performed to identify predictive factors.Results: Between January 1, 2005 and December 31, 2008, 4250 patients fulfilled inclusion criteria (2309 BKAs and 1941 AKAs). WOs were 10.4% for BKAs and 7.2% for AKAs. For BKAs, increasing elevation in international normalized ratio (INR) predicted more WOs (P = .008, odds ratio [OR] 1.5 for every integral increase in INR) as did age 50 to 59 compared with older patients (P = .002, OR 1.9). For AKAs, being a current smoker predicted more WOs (P = .0008, OR 1.8) as did an increasing body mass index (BMI) (P = .02, OR 1.3 for every 10 kg/m(2) increase in BMI). Mortality was 7.6% for BKAs and 12% for AKAs. Complete functional dependence was most predictive of mortality following AKA (P < .0001, OR 2.5). Medical comorbidities such as history of myocardial infarcation (MI) (OR 1.8), congestive heart failure (CHF, OR 1.6), and chronic obstructive pulmonary disease (COPD, OR 1.6) predicted mortality following BKA, while dialysis use (OR 2.4), CHF (OR 2.3), and COPD (OR 2.1) predicted mortality following AKA.Conclusions: Wound occurrences and mortality rates after major amputation for CLI continue to be a prevalent problem. Normalization of the INR prior to BKA should decrease WOs. Heightened awareness in higher risk patients with improved preventive measures, earlier disease recognition, better treatments, and increased education remain critical to improving outcomes in an already stressed patient cohort. (J Vase Surg 2011;54:1374-82.)